Key Finding (Significant Health Needs) Addressed in Implementation Plans: i. Mental Health ii. Obesity (and being overweight) iii.

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1 Spectrum Health Zeeland Hospital Implementation Plan July 2018 June 2021 Summary of Key Findings (Significant Health Needs) Identified in the Community Health Needs Assessment (CHNA) A hospital facility s implementation strategy to meet the community health needs identified through the hospital facility s CHNA is a written plan that, with respect to each key finding (significant health needs) identified through the CHNA, either (1) Describes how the hospital facility plans to address the health need; or (2) Identifies the health need as one the hospital does not intend to address and explains why the hospital facility does not intend to address the health need. Information needed to identify and determine the community s key findings (significant health needs) was obtained by sending out community health surveys to residents, interviews, and online surveys with community healthcare professionals and community leaders. Secondary data was gathered from state, local, and national databases to supplement the overall findings and needs identified. Key Finding (Significant Health Needs) Addressed in Implementation Plans: i. ii. Obesity (and being overweight) iii. Access to Care Other Key Findings (Significant Health Needs) Identified in the CHNA But Not Addressed in this Plan Each of the health needs listed below is important and is being addressed by numerous programs and initiatives operated by the Hospital, other organizations within Spectrum Health, and other community partners of the Hospital. However, the Hospital will not address the following significant health needs identified in the CHNA as part of this Implementation Plan due to limited resources and the need to allocate significant resources to the significant health needs identified above. i. Substance Abuse ii. Negative Social Indicators iii. Chronic Disease iv. Presence of risk behaviors v. Need for an integrated, holistic, or biopsychosocial perspective to address health and health care issues vi. Health Disparities 1

2 Key Findings (Significant Health Needs) Spectrum Health Zeeland Community Hospital Health Needs Assessment Implementation Plan July 2018 June 2021 Population Served Action Measurable Impact All residents of the SHZCH Primary Service Area (PSA) From the Behavioral Risk Factor Survey (BRFS) and the Youth Assessment Survey: 28.9% of youth were depressed, 19.4% have seriously thought about suicide, 13.6% have made a plan to attempt suicide and 8% have attempted suicide. All of those numbers have increased since In addition, 70% of people who die by suicide saw their health care provider within the last 30 days. 1. Work with the Spectrum Health Medical Group (SHMG) to reinforce and support the Blue Envelope Program, insuring that all staff are comfortable with the process of identifying, handling and referring a patient at risk of attempting suicide. Spectrum Health Zeeland Community Hospital (SHZCH) will encourage training, participation and tracking of the number of blue envelopes used in the physician practices (588 Lakewood, Zeeland Physicians and Georgetown Physicians). The use of blue envelopes will insure that early intervention happens and will lead to 0 suicides. 2. Work with SHMG to revise blue envelope materials so that they are appropriate for a school setting and obtain a baseline from parents and staff s level of comfort with addressing someone at risk of attempting suicide. Pilot the Blue Envelope Program in a school. 1a. Establish a baseline number of blue envelopes used in FY2019. To be completed by 6/30/2019 1b. Increase the number of blue envelopes used by 10% in FY2020 1c. Increase the number of blue envelopes used by an additional 10% in FY2021 2a. Monitor and record the number of blue envelopes used in the school setting in the first year of implementation for FY2019. To be completed by 6/30/ b. For FY2020, Increase the number of blue envelopes used in the school setting by 10%. To be completed by 6/30/

3 Key Findings (Significant Health Needs) Spectrum Health Zeeland Community Hospital Health Needs Assessment Implementation Plan July 2018 June 2021 Population Served Action Measurable Impact 2c. For FY2021, Increase the number of blue envelopes used in the school setting by 10%. To be completed by 6/30/ d. Establish a baseline of parent and staff awareness and comfort with addressing students and staff at risk of attempting suicide in FY2019. To be completed by 6/30/ e. For FY2020, Increase parent and staff awareness and comfort with addressing students and staff at risk of attempting suicide by 10% over baseline. To be completed by 6/30/ e. For FY2021, Increase parent and staff awareness and comfort with addressing students and staff at risk of attempting suicide by 10% over baseline. To be completed by 6/30/

4 Key Findings (Significant Health Needs) Spectrum Health Zeeland Community Hospital Health Needs Assessment Implementation Plan July 2018 June 2021 Population Served Action Measurable Impact All residents of the SHZCH Primary Service Area (PSA) continues as a critical issue and is not improving. Top four concerns from the Community Health Needs Assessment (CHNA): Stigma with mental illness, lack of programs/services, lack of funding for mental health services, lack of psychiatrists/therapy. 1. Assess the number of QPR (Question. Persuade. Refer three steps anyone can learn to help prevent suicide) trainings that are held in Ottawa County. 1. Collaborate with the Suicide Prevention Task Force of Ottawa County to develop a list of QPR resources available in the community as a baseline. To be completed by 6/30/ Offer additional QPR trainings in Ottawa County in partnership with the Ottawa County Suicide Prevention Task Force. Offer and/or host additional QPR trainings in Ottawa County as needed. 2a. In FY2020, Pilot 2 additional QPR trainings in the community to determine effectiveness and demand. To be completed by 6/30/ b. In FY2021 Continue to offer and/or host 2 QPR trainings in Ottawa County if needed. To be completed by 6/30/2021. All residents of the SHZCH Primary Service Area (PSA) Spectrum Health will implement a 24/7 Psychological consultative/rapid response service within the Grand Rapids based health center. This will allow for the services to be delivered in a telehealth/virtual manner. Within the regional hospital spaces, such as SHZCH, we will offer telehealth psych consultative services 24 hour/7 day a week. 1. Establish a performance baseline one year after the service is established. To be completed by 6/30/ a. In subsequent years, increase telepsych consults by 10%. To be completed in by 6/30/2021 and 6/30/

5 Spectrum Health Zeeland Community Hospital Health Needs Assessment Implementation Plan July 2018 June 2021 Obesity Key Findings (Significant Health Needs) Population Served Action Measurable Impact Obesity (and being overweight) Youth in grades K 5 in one school building in Ottawa County Enlist other community partners and one school to pilot the Win With Wellness Fit Club (a program from Ludington Hospital). The program seeks a proactive approach to imbed healthy behaviors at a young age when successful intervention can more effectively occur. The program is designed to: increase knowledge and awareness of healthy lifestyle choices, create opportunities for physical activities, foster teamwork, goal setting, sportsmanship and a proactive approach to health and offer health educational opportunities around important health topics. 1a. Secure one elementary school to pilot the Win With Wellness Fit Club. To be completed by 6/30/ b. Secure three community partners to support the Fit Club 100 Mile Challenge by offering incentives. To be completed by 6/30/ a. Pilot year 1 education programming modules in one school. To be completed by 6/30/ b. Institute year 2 education programming modules in pilot school. To be completed by June a. Have 50% of students at the school participate in the 100 Mile Challenge. To be completed by 6/30/ b. Increase the number of students participating in the 100 Mile Challenge by 10%. To be completed by 6/30/2021. Obesity (and being overweight) All residents of the SHZCH Primary Service Area (PSA) From the BRFS (2017), only 49.5 % of obese adults and 22.7% of overweight adults are getting advice from a health professional about their weight. 1a. Establish a baseline of SHMG physicians who talk with their patients about their weight. To be completed by 6/30/2019. Collaborate with the Spectrum Health Medical Group (SHMG) to develop a strategy that will 1b. Develop strategy, in partnership with SHMG, for weight discussions to occur more frequently. To be 5

6 Spectrum Health Zeeland Community Hospital Health Needs Assessment Implementation Plan July 2018 June 2021 Obesity Key Findings (Significant Health Needs) Population Served Action Measurable Impact encourage physicians to talk with patients about weight. Create a resource which physicians can give to their patients which will list available weight management resources. The Ottawa County 2018 Community Health Improvement Plan recommends physicians provide thoughtful intervention, recommendations and resources to patients during office visits with care providers. completed by 6/30/ c. Establish a group of physicians to pilot the strategy with patients above a certain BMI threshold. To be completed by 12/31/ d. Increase the number of physicians who talk with their patients about their weight by 10% over baseline. To be completed by 6/30/

7 Health Need Spectrum Health Zeeland Community Hospital Health Needs Assessment Implementation Plan July 2015 June 2018 Access to Care Population Served Action Measurable Impact Access to Care All residents of the SHZCH Primary Service Area (PSA) Per Ottawa County CHNA: Cancer death rates are higher than other causes of death; cancer is the second most important health problem in the community; cancer is the leading cause of death in Ottawa County. Increase use of the Oncology Distress Screening Tools (DST s) to determine what needs that the cancer patient has (transportation/housing/finance/emotional problems/family problems/etc.) Due to cancer being a widespread issue in Ottawa County, the DST s will help us identify how to best meet the needs of the patients in our community. 1a. Establish a baseline average per month of DST s used. To be completed by 6/30/2019 1b. In FY2020, increase the DST s used per month by 10%. To be completed by 6/30/ c. In FY2021, increase the DST s used per month by an additional 10%. To be completed by 6/30/ d. Track identified patient needs on the DST s and review quarterly to insure problems are either resolved or referred to appropriate community resources. In FY2019, have 4 quarterly reviews by 6/30/ e. In FY2020, have 4 quarterly reviews by 6/30/ f. In FY2021, have 4 quarterly reviews by 6/30/2021. Access to Care All underserved residents of Ottawa County On the BRFS in 2017, only 84.4% of people had confidence in navigating the Healthcare system. The percentage of underserved adults who had trouble meeting their healthcare needs in the past year (2017) was 42.1%. Increase the number of referrals from the Spectrum Health Medical Group in Ottawa County (588 Lakewood, Georgetown Physicians, Zeeland Physicians, Holland Community Health Center) and from SHZCH into the Ottawa Pathways to Better Health (OPBH) community health worker program. The OPBH program is a collaborative pilot program in Ottawa County that is financially supported by SHZCH and we serve on the program steering committee. OPBH began From the established baseline of 4 referrals from January June 2018: 1a. Increase the number of referrals to 14 in FY2019. To be completed by 6/30/ b. Increase the number of referrals to 18 in FY2020, To be completed by 6/30/ c. Increase the number of referrals to 24 in FY2021. To be completed in 6/30/

8 Health Need Spectrum Health Zeeland Community Hospital Health Needs Assessment Implementation Plan July 2015 June 2018 Access to Care Population Served Action in By establishing a system to assist all community members that we encounter who qualify for the program, we can help them meet their healthcare needs and provide them with support from an OPBH worker as they navigate the healthcare system. Measurable Impact Access to Care All residents of the SHZCH Primary Service Area (PSA) Key Stakeholders and Key Informants recognized that certain subpopulations of underserved have transportation barriers to accessing health care. Next to inability to pay for health care, underserved adults listed transportation issues as the top reason they have trouble meeting health care needs in the past 2 years. (16.1%) Support the new MAX (Macatawa Area Express) bus stop at SHZCH by promotion and marketing efforts. From the established baseline of 504 referrals from January June 2018: 1a. Increase Max Bus usage to 750 year. To be completed by 6/30/ b. Increase Max Bus usage to 950 year. To be completed by 6/30/ c. Increase Max Bus usage to 1150 year. To be completed by 6/30/2021. The MAX operates hourly fixed bus routes and an evening twilight route Monday through Saturday and will enable patients with transportation issues access to both the hospital and the various physician offices and clinics on premises. It is anticipated that the new MAX bus stop will begin services to SHZCH in August,

9 Spectrum Health Hospitals Community Health Needs Assessment (CHNA) Implementation Plan Glossary of Definitions For the period of July 2018 June 2021 Advanced directive Advanced Practice Provider (APP) Bariatrics Behavioral Health Blue Envelope A legal document (as a living will) signed by a competent person to provide guidance for medical and healthcare decisions (such as the termination of life support or organ donation) in the event the person becomes unable to make such decisions. Mid level practitioners who are health care providers who have received different training and have a more restricted scope of practice than physicians and other health professionals in some states, but who do have a formal certificate and accreditation through the licensing bodies in their jurisdictions. Examples include, but may not be limited to, Nurse Practitioners, Physician Assistants, and Nurse Midwives. A Nurse Practitioner is a registered nurse who has acquired the knowledge base, decision making skills, and clinical competencies for expanded practice beyond that of an RN, the characteristics of which would be determined by the context in which he or she is credentialed to practice. Physician Assistants are concerned with preventing and treating human illness and injury by providing a broad range of health care services under the supervision of physician or surgeon. They conduct physical exams, diagnose and treat illnesses, order and interpret tests, develop treatment plans, perform procedures, prescribe medications, counsel on preventive health care and may assist in surgery. Nurse Midwives are advanced practice registered nurses who provide counseling and care during pre conception, pregnancy, childbirth and the postpartum period. The branch of medicine that deals with the causes, prevention, and treatment of obesity. Covers the full range of mental and emotional wellbeing for the basics of how we cope with the challenges of day to day life, to the treatment of mental illnesses, such as depression or personality disorders, as well as substance abuse and other addictive behaviors. Spectrum Health created an innovative approach to Suicide Prevention by designing a Suicide Safety Behavior Kit (SSBK). This SSBK is kept in an easily identified Blue Envelope and contains guidelines and crisis response protocols for a First Responder, Second Responder and Clinical Lead (a provider, social worker, physician assistant, registered nurse, etc.), instructing each team member in an office setting on how to respond to a person who reveals suicidal thoughts or behaviors. These comprehensive protocols can be quickly and compassionately activated by each team member at a moment s notice when someone uses the code words Please get me a Blue Envelope. 9

10 Spectrum Health Hospitals Community Health Needs Assessment (CHNA) Implementation Plan Glossary of Definitions For the period of July 2018 June 2021 Cardiovascular and Thoracic (CVT) Chaplaincy Program Chronic disease Colon cancer screenings Convenient Care Emergency Department (ED) Federally Qualified Health Center (FQHC) FitKids360 Full Time Equivalent (FTE) HBA1C A field of medicine focused on the heart, lungs, esophagus, and other organs in the chest. This includes specialists such as cardiothoracic surgeons, cardiovascular surgeons, general thoracic surgeons, and congenital heart surgeons. A member of the clergy trained to listen to the patient's story, to be present to the patient's values, and to reframe the crisis in the context of these values. These areas include risk assessment, crisis intervention, advocacy, cultural and religious diversity, ethics, integration of the patient's story into a larger faith perspective, ritual support, end of life issues, and bereavement and grief. A persistent or recurring disease that affects a person for at least three months. Tests to detect polyps and early cancers in the intestines. This type of screening can find problems that can be treated before cancer develops or spreads. Regular screenings may reduce the risk of pain and death caused by colorectal cancer. Clinics that are a category of walk in clinics that treat uncomplicated minor illnesses and provide preventative healthcare services. The department of a hospital responsible for the provision of medical and surgical care to patients arriving at the hospital in need of immediate care. Federally qualified health centers (FQHCs) include all organizations receiving grants under Section 330 of the Public Health Service Act (PHS). FQHCs qualify for enhanced reimbursement from Medicare and Medicaid, as well as other benefits. FQHCs must serve an underserved area or population, offer a sliding fee scale, provide comprehensive services, have an ongoing quality assurance program, and have a governing board of directors. FitKids360 is a healthy lifestyle program for overweight children and their families. A unit that indicates the workload of an employed person (or student) in a way that makes workloads or class loads comparable across various contexts. An FTE of 1.0 is equivalent to a full time worker while an FTE of 0.5 signals half of a full work. The A1c test (also known as HbA1c, glycated hemoglobin or glycosylated hemoglobin) is a blood test that 10

11 Spectrum Health Hospitals Community Health Needs Assessment (CHNA) Implementation Plan Glossary of Definitions For the period of July 2018 June 2021 correlates with a person s average blood glucose level over a span of a 90 days. Institute for Healthcare Improvement (IHI) Integrating behavioral health collaborative care programs IHI is a nonprofit organization focused on motivating and building the will for change, partnering with patients and health care professionals to test new models of care, and ensuring the broadest adoption of best practices and effective innovations. The systematic coordination of general and behavioral healthcare. Integrating mental health, substance abuse, and primary care services produces the best outcomes and proves the most effective approach to caring for people with multiple healthcare needs. Low birth weight (LBW) Low birth weight (LBW) is defined as a birth weight of a live born infant of less than 2,500 g (5 pounds 8 ounces) regardless of gestational age. Mammogram Marketplace Maternal Infant Health Program Medicaid Medicare The process of using low energy X rays to examine the human breast, which is used as a diagnostic and screening tool. The goal of mammography is the early detection of breast cancer, typically through detection of characteristic masses and/or microcalcifications. Also known as the Health Insurance Exchange is the place where people without health care insurance can find information about health insurance options and also purchase health care insurance. Programs to improve women s health before, during, and after pregnancy to reduce both short and longterm problems. A United States federal health care program for families and individuals with low income and limited resources. A United States federal system of health insurance for people over 65 years of age and for certain younger people with disabilities. Also referred to as Behavioral Health, covers the full range of mental and emotional wellbeing for the basics of how we cope with the challenges of day to day life, to the treatment of mental illnesses, such as depression or personality disorders, as well as substance abuse and other addictive behaviors. 11

12 Spectrum Health Hospitals Community Health Needs Assessment (CHNA) Implementation Plan Glossary of Definitions For the period of July 2018 June 2021 Metrics Mothers Offering Mothers Support (MOMS) Next third available appointment Obstetrics/Gynecology (OB/GYN) Oncology Distress Screening PAP Smear Primary Care Primary Care Emergency Department (ED) Sensitivity Psychiatry Behavioral Medicine Integrated (PBM+) Question. Persuade. Refer (QRP) A standard for measuring or evaluating something, especially one that uses figures or statistics A Spectrum Health Healthier Communities program that serves Medicaid beneficiaries who are pregnant and their newborns who are most likely to experience serious health problems due to psychosocial, socioeconomic and/or nutritional risk factors. A measurement of the patient's ability to seek and receive care with the provider of their choice, at the time they choose, regardless of the reason for their visit. Counting the third next available appointment is the healthcare industry's standard measure of access to care and indicates how long a patient waits to be seen. An obstetrician/gynecologist is a physician specialist who provides medical and surgical care to women and has particular expertise in pregnancy, childbirth, and disorders of the reproductive system. Cancer patients are screened to assess the psychological, social, financial, and behavioral issues that may interfere with a patient s treatment plan and adversely affect treatment outcomes so that patients are given appropriate resources and/or referral for psychosocial needs. A screening test for cervical cancer. Cells scraped from the opening of the cervix are examined under a microscope. The cervix is the lower part of the uterus (womb) that opens at the top of the vagina. The day to day health care given by a health care provider. Typically this provider acts as the first contact and principal point of continuing care for patients within a health care system, and coordinates other specialist care that the patient may need. Patients using the hospital emergency departments for non urgent care and for conditions that could have been treated in a primary care setting. Embedding behavioral health services into a care setting that includes universal screening for depression, anxiety, and substance abuse. It enables triage to appropriate behavioral health resources based on risk. This will allow for improved health outcomes and the identification and treatment of conditions that were previously unknown (that impact overall health). A training program to reduce suicidal behaviors and save lives by providing innovative, practical and proven 12

13 Spectrum Health Hospitals Community Health Needs Assessment (CHNA) Implementation Plan Glossary of Definitions For the period of July 2018 June 2021 suicide prevention training to help decrease stigma and empower all people, regardless of background, to make a positive difference in the mental health of the people that they know. Readmission Referral Sliding fee scale Smoking cessation Substance Use Disorder Telehealth or Telemedicine Trimester Triple Aim Very low birthweight (VLBW) Virtual A subsequent admission to the hospital that occurs within 30 days of a previous admission s discharge. An act of referring someone or something for consultation, review, or further action. Variable pricing for products, services, or taxes based on a customer's ability to pay. Discontinuation of the habit of smoking, the inhaling and exhaling of tobacco smoke. Substance use disorders occur when the recurrent use of alcohol and/or drugs causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home. A diagnosis of substance use disorder is based on evidence of impaired control, social impairment, risky use, and pharmacological criteria. The use of medical information exchanged from one site to another via electronic communications to improve a patient s clinical health status. Telemedicine includes a growing variety of applications and services using two way video, , smart phones, wireless tools and other forms of telecommunications technology. A period of three months, especially as a division of the duration of pregnancy. The pursuit of improving the experience of care, improving the health of populations, and reducing per capita costs of health care. A birth weight of a live born infant of less than 1,500 g (3 pounds 5 ounces) regardless of gestational age. The use of information exchanged from one site to another via electronic communications. Virtual technology includes a growing variety of applications and services using multi way video, , smart phones, wireless tools and other forms of telecommunications technology. 13